Personal Assistant Application Form Submission 

Title *: 
First Name *:  
Address 2: 
Town *: Pontypridd 
County *:
Postcode *: 
Phone number *: 
Please enter your email address for submission confirmation. *:
Reference number of job being applied for 
I confirm that I have the right to work in the UK and am able to prove my eligibility status when required to do so. *: Yes 
Please read the Job Description carefully before providing information in this Section of the Application Form. Give details of your previous employment or experience which you think would help you to do this job. *: I have no experience in this sector but would like to socialise with people who need moral and physical support. 
What qualities do you think are important when working as a personal assistant with a disabled person? *: 1. understand their struggle and feelings from inside. 2. Listen to their problems and share each other 3. Be kind and have a relationship between each other so that they can share their feelings to you. 
How do you think you can contribute towards the needs and the independence of a disabled person? *: Since Im a person who love to socialise with people and Im blessed to help or give my support to a disabled person who are in need. Ill have a relationship where the person shouldnt think that he or she is disabled. Even if not completely but Ill try to give my hand for them whenever they are in need. 
What is it about PA work which appeals to you? *: Its nothing but a responsibility we do for our parents when they are old same way its someones parents who need are support. And Ill be glad to help anyone same as my parents. 
What are your hobbies/interests?:I love football and working out in gym Interact with new people and explore the possibilities in culture or any traditional sort. Make friends in any possible way that will help me in the future. 
Would you consider a casual position if you are unsuccessful with this job? *: Yes 
Do you drive? *: Yes 
Are you a vehicle owner? *: No 
Do you smoke? *: No 
Are you able to undertake training? *: Yes 
What days/nights are you able to work, or prefer to work? *: Friday, Saturday, Sunday and Monday(day/night) 
Are there any circumstances which would prevent you from providing cover or swapping a shift? *: Yes 
If you would like to expand on the answers given above? Please use the box below.: 
Name *: 
In what capacity do you know this person (should not be a family member)? *: 
In what capacity do you know this person (should not be a family member)? *: 
Is there is any such information you wish to disclose, relating to any cautions or convictions which will appear on your mandatory DBS check? *: No/ 
Please provide details if necessary: 
I agree that there is nothing which would prevent me from doing this job. *: Yes 
I consent to the above *: No 
I agree that the information I provide will be posted to the Dewis CIL PA noticeboard (all personal information will be withheld).: Yes 
What geographical area’s are you able to cover?: 
How many hours of work can you offer per week?:20 
Please indicate the approximate times that you are available for work throughout the week.: Monday PM/Wednesday PM/Friday PM/Saturday PM/Sunday PM / 
Further Information: